Medical insurance premiums set to rise

People on health insurance should brace for a considerable increase in monthly contributions as efforts gather momentum to cushion them against huge co-payments and shortfalls emanating from charges demanded by service providers mainly in the private sector.

A new reference list compiled by the Association of Health Care Funders of Zimbabwe (AHFoZ) is expected to see medical aid societies reimbursing general practitioners a ceiling of $321,20 for initial consultations by their members.

The medical aid societies are also expected to reimburse specialist doctors an average of $1 000 for initial visits.

Although this reference pricing list, which became effective on November 1 is likely to see an increase in members’ contributions towards health insurance, stakeholders in the industry said if implemented, the increases will ensure service provision with little or no co-payments and shortfalls on patients, which has been the case of late.

AHFoZ chief executive Ms Shylet Sanyanga told The Herald yesterday that medical aid societies were consulting with employers on the practicability of the charges on the reference list.

“AHFoZ member societies are in the process of engaging their respective member organisations on contribution increases for them to be able to absorb a recent fee review recommended by AHFoZ effective, 1 November, 2019.

“Our hope as AHFoZ is to see a significant reduction or elimination of shortfalls,” said Ms Sanyanga.

She said AHFoZ was also encouraging medical aid societies to offer flexible packages.

“We are working towards eliminating the information asymmetry pertaining to the relationship between the contribution level and the prevailing costs. Contributing medical aid members should be made aware of how much healthcare services are costing, in relation to the contribution, so that they make informed decisions of package options,” said Ms Sanyanga.

She said AHFoZ had recommended to its member societies that they should identify and establish networks with cooperating service providers.

The providers will then form a pool to work with the insurers.

Some medical aid societies have since adjusted their member contributions to at least $450 per member per month, in line with the new AHFoZ recommendations.

Zimbabwe Medical Association (ZiMA) chairperson for the national tariff liaison committee Dr Shingirirai Meki welcomed the development saying if honoured, they will address challenges of huge co-payments and shortfalls.

“If implemented, this will bring a huge relief to patients by alleviating shortfalls especially on consultations and basic care,” said Dr Meki.

He said the reference list was also likely to bring back sanity in pricing of health services.

Dr Meki said pricing of health services was guided by a 2014 Government Gazette, which pegged consultation fees for general practitioners at US$35 a visit and about US$70 for specialists.

“Some providers were then converting these figures to the prevailing interbank rate of the day. There was, however, no uniformity on the pricing,” said Dr Meki.

Of late, medical aid societies had lost their relevance as patients had to grapple with huge co-payments and shortfalls as a result of high costs being charged by service providers.

Although service providers had increased costs, health insurers could not increase member contributions, which subsequently leads to increased reimbursements to providers as salaries for most members had also not been adjusted.